HB 1074 - Coverage for Dialysis Treatment

• Insurers and health maintenance organizations cannot require insured individuals to travel more than 30 miles from home for dialysis treatment if a facility exists within that radius, or travel farther than the nearest available facility regardless of network status.

• Insurers and HMOs must make all dialysis treatment claim payments directly to the dialysis facility upon request, rather than to the insured.

• Dialysis coverage cannot have less favorable benefit restrictions, deductibles, copayments, coinsurance, or lifetime maximums compared to other medical and surgical benefits under the policy.

• Dialysis facilities cannot bill insured individuals for amounts exceeding what the insurer pays plus applicable out-of-pocket costs; insurers may suspend reimbursement to facilities that violate this requirement until the bill is canceled and full reimbursement made.

• Establishes binding arbitration or mediation procedures for disputes between dialysis facilities and insurers/HMOs regarding contract term changes that cannot be resolved through existing dispute resolution provisions.